Provider Demographics
NPI:1033198072
Name:GOLDIN, NATHAN P (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:P
Last Name:GOLDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CLEARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1815
Mailing Address - Country:US
Mailing Address - Phone:757-457-5100
Mailing Address - Fax:757-961-3696
Practice Address - Street 1:7185 HARBOUR TOWNE PKWY S STE 200
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3796
Practice Address - Country:US
Practice Address - Phone:757-457-5100
Practice Address - Fax:757-961-3934
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101036562208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA25058OtherSENTARA HEALTHCARE
VA007502044Medicaid
VA332753OtherANTHEM BC BS
VA340000576Medicare ID - Type Unspecified
VA007502044Medicaid
C36625Medicare UPIN